CurrentCignaPolicy ST005

Topical Agents for Atopic Dermatitis Step Therapy Policy for Employer Plans

Cigna's step therapy coverage policy for certain topical nonsteroidal and comparator topical agents used to treat mild-to-moderate atopic dermatitis for employer plan members; describes required Step 1 agents before coverage of Step 2 agents and age-based exception.

Policy Summary

PayerCigna

PolicyTopical Agents for Atopic Dermatitis Step Therapy Policy for Employer Plans

Policy CodePolicy ST005

Change TypeNew policy

Effective DateApr 1, 2026

Next Review Date

Key ActionConfirm patients have tried a Step 1 product (generic pimecrolimus, tacrolimus ointment, or prescription topical corticosteroid) or meet the age-based exception before approving Step 2 products.

SourceLink

POLICY UPDATE CHANGES

New step therapy policy created for topical agents (Eucrisa and Zoryve) with Step 1 and Step 2 designations.

2Step 2 products listed

3Step 1 product groups

1 yearAuthorization duration

age <2Eucrisa exception

Coverage Criteria

Step therapy coverage criteria (Initial)

Topical Agents for Atopic Dermatitis medications are covered as medically necessary when ONE of the following are met:

Step therapy satisfied: Patient has tried a Step 1 product (generic pimecrolimus 1% cream, generic tacrolimus ointment 0.03% or 0.1%, or prescription topical corticosteroids)

If met, approve Step 2 product

Age-based exception for Eucrisa: Patient is < 2 years of age — approve Eucrisaage < 2 years

Eucrisa is approved for patients ≥ 3 months per product labeling; policy makes exception to approve if < 2 years

Any other exception outside the two listed criteria is considered not medically necessary.

Requests that do not meet either of the listed criteria — i.e., the patient has not tried a Step 1 product and does not meet the age-based exception for Eucrisa — are considered not medically necessary.

Policy Summary

PayerCigna

PolicyTopical Agents for Atopic Dermatitis Step Therapy Policy for Employer Plans

Policy CodePolicy ST005

Change TypeNew policy

Effective DateApr 1, 2026

Next Review Date

SourceLink

On This Page

Provider Actions and Authorization

Prior Authorization

Prior authorization duration

Step therapy prior authorizations for Step 2 products (Eucrisa, Zoryve) are approved for a 1-year duration. Meeting the Step Therapy program criteria does not satisfy any other prior authorization or medical necessity requirements.

Approvals are valid for 1 year from the date of authorization.
Meeting step therapy criteria does not waive other prior authorization or medical necessity rules.

Step Therapy

Step therapy requirements

Step 1 products must be tried before Step 2 products are approved. Step 1: generic pimecrolimus 1% cream; generic tacrolimus ointment (0.03% and 0.1%); prescription topical corticosteroids (brand or generic). Step 2: Eucrisa and Zoryve (0.05% and 0.15% strengths).

Step 1 products: generic pimecrolimus 1% cream; generic tacrolimus ointment (0.03% and 0.1%); prescription topical corticosteroids.
Step 2 products: Eucrisa; Zoryve cream 0.05% and 0.15%.

Documentation Required

Billing and coding documentation requirement

When billing, providers must use the most appropriate codes as of the effective date. Claims for services not accompanied by required or covered codes may be denied or affected.

Use current, appropriate CPT/HCPCS/ICD-10/NDC codes as of the claim/service date.
Claims missing required documentation or covered codes may be denied as not covered.

Denial Risk

Denial risk for not meeting Step Therapy

Requests for Step 2 products (Eucrisa or Zoryve) may be denied as not medically necessary if the Step Therapy rule is not met at the point of service.

If the patient has not tried an applicable Step 1 Product, a Step 2 request may be denied.
Exception: patients < 2 years of age — Eucrisa may be approved without trying Step 1.

Definitions

Eucrisa (crisaborole)

Drug & formulationEucrisa — crisaborole 2% ointment.

Mechanism/classTopical phosphodiesterase-4 (PDE4) inhibitor.

Indication (age) per prescribing infoIndicated for mild-to-moderate atopic dermatitis in patients ≥ 3 months of age.

Policy exceptionPolicy allows approval of Eucrisa for patients < 2 years of age as a Step 2 exception.

Zoryve (roflumilast)

Drug & formulationsZoryve — roflumilast cream 0.05% and 0.15%.

Age-specific strengths0.05% cream indicated for ages 2–5; 0.15% cream indicated for ages ≥ 6.

IndicationTopical treatment of mild-to-moderate atopic dermatitis.

Topical calcineurin inhibitors

AgentsTacrolimus ointment and pimecrolimus cream.

RoleTopical calcineurin inhibitors — second-line topical anti-inflammatory therapy for atopic dermatitis (short-term and non-continuous chronic treatment).

Age/strength notesTacrolimus 0.03% and pimecrolimus are indicated for adults and children ≥ 2 years; tacrolimus 0.1% has pediatric data but is not pediatric-approved.

OpenPayer

Topical Agents for Atopic Dermatitis Step Therapy Policy for Employer Plans

Coverage Criteria

Coding and Products

Provider Actions and Authorization

Background

Definitions

Eucrisa	crisaborole 2% ointment
Zoryve	roflumilast 0.05% and 0.15% cream
generic pimecrolimus 1% cream	Step 1 topical comparator
generic tacrolimus ointment 0.03% and 0.1%	Step 1 topical comparator
prescription topical corticosteroids	Step 1 topical comparator